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  1. #1
    wowmd is offline Member
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    Moonlighting vs. Night Float ?

    Hey guys, I'm new to this particular forum.
    But what's the difference between moonlighting and night float?
    I think i know what moonlighting is all about, but what is exactly a night float?
    In FREIDA, I noticed that many hospital programs offer moonlighting, but they only offer night float STARTING in their 2nd year....

    Can someone clear this for me?

  2. #11
    wowmd is offline Member
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    So are you saying that "In House" moonlighting counts in that 80 hr rule thing, but if you do something outside the hospital, then it's not counted into that 80 hr rule?

    and if you dont mind, can you tell me where you did your residency and in what field?


  3. #12
    sean is offline Member
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    Hi wow,

    Here's a copy of ACGME guidelines (may be an old copy but I copied it from the ACGME site) - S :

    Frequently-Asked Questions about the Proposed ACGME Common Duty Hour Standards
    On July 1, 2003, the ACGME’s new common duty hour standards became effective for all
    accredited residency programs. The goal is to set a minimum standard; individual RRCs may set
    more restrictive standards, as warranted by patient safety, resident education and resident wellbeing
    considerations in their discipline.
    In the spring of 2003, the ACGME published the first set of responses to frequently asked
    questions (FAQs) about the common duty hour standards. The answers below some updated
    responses in areas where the ACGME and the Residency Review Committees (RRCs) have
    refined the standards, as well as clarifications related to implementation and monitoring of the
    standards. The responses still represent a general answer based on the common standards, and
    programs should address specialty-specific question to their RRC team.
    Question: What is the definition of “on-call duty”?
    Answer: On-call duty is defined as a continuous duty period between the evening hours of the
    prior day and the next morning, generally scheduled in conjunction with a day of patient care
    duties prior to the on-call period. Call may be taken in-house or from home. Call from home is
    appropriate if the service intensity and frequency of being called is low.
    On-call duty excludes regular duty shifts worked during night hours, as is done in Emergency
    Medicine. It also excludes night float assignment used in many programs to replace on-call shifts
    to reduce the continuous waking hours and strenuous nature of some in-house call.
    Question: How is the 24-hour limit on in-house call duty applied?
    Answer: The activity that drives the 24-hour limit is “continuous duty.” If a resident spends 12
    hours in the hospital caring for patients, performing surgery, or attending conferences, followed
    by 12 hours on-call, he/she has spent 24 hours of “continuous duty” time, and is limited to up to 6
    additional hours for patient care transfer, educational debriefing and didactic activities.
    Question: Which standards apply to time in the hospital after being called in from home call?
    Answer: For call taken from home (pager call), the time the resident spends in the hospital after
    being called in is counted toward the weekly duty hour limit. The only other numeric duty hour
    standard that applies is that one day in seven must be free of all patient care responsibilities,
    which includes home call. The ACGME also requires that programs monitor the intensity and
    workload resulting from home call, through periodic assessment of the frequency of being called
    into the hospital and the length and intensity of the in-house activities.
    Question: Is it permissible for resident to take call from home for extended periods, such as a
    Answer: The requirement that one day in seven must be free of patient care responsibilities
    would prohibit residents from being assigned home call for an entire month. Assignment of a
    partial month (more than six days but less than 24 days) is possible. Programs considering this
    option need to check with their RRC, since the application of this standard varies among RRCs.
    Question: How do the ACGME common duty hour standards apply to research activities?
    The ACGME duty hour standards pertain to all required hours in the residency program (the
    only exceptions are reading and self-learning and time on call from home during which the
    resident is not required to be in the hospital). Research of up to 6 months scheduled during one or
    more of the accredited years of the program is required in many specialties and may also contain
    a clinical element. When research is a formal part of the residency and occurs during the
    accredited years of the program, research hours or any combination of research and patient care
    activities must comply with the weekly limit on hours and other pertinent duty hour standards.
    There are only two situations when the ACGME duty hour standards do not apply to research.
    One is when programs offer an additional research year that is not part of the accredited years. In
    this case the ACGME standards do not apply to that year. The other case is when residents
    conduct research on their own time, which makes these hours identical to other personal pursuits.
    One would expect that the combined hours spent on self-directed research and program-required
    activities meet the test for a reasonably rested and alert resident when he or she participates in
    patient care.
    Recently, some programs have view the research rotations as an opportunity to add clinical
    activities, such as research residents covering “night float.” This creates an emerging “gray area”
    in which research and clinical assignments overlap, which could result in hours that exceed the
    weekly limit and could also seriously undermine the goals of the research rotation. RRCs have
    traditionally been concerned that required research not be diluted by combining it with significant
    patient care assignments. This suggests limits on clinical assignments during research rotations,
    both to ensure safe patient care, resident learning and resident well-being, and to promote the
    goals of the research rotation.
    Question: The ACGME’s definition of duty hours does not explicitly mention participation on
    hospital committees, time spent interviewing residency candidates and similar activities? Are
    these activities included in the count of duty hours? .
    Answer: Yes, hours spent on activities that are required by the accreditation standards, such as
    membership on hospital committee, or that are accepted practice in residency programs, such as
    residents participating in interviewing residency candidates, must be included in the count of duty
    hours? It is not acceptable to expect residents to participate in these activities on their own hours;
    nor should residents be prohibited from taking part in them. Programs should note that these
    activities do not consume significant hours when averaged over a given period, and their benefits
    to the residency program are substantial.
    Question: A journal club is held in the evening for two 2 hours, outside the hospital. It is not
    held during the regularly scheduled duty hours, and attendance strongly encouraged but not
    mandatory. Do these hours count toward the 80-hour weekly total?
    Answer: Yes, with attendance “strongly encouraged,” these hours should be included because
    duty hours apply to all required hours in the program, and it is difficult to distinguish between
    “strongly encouraged” and required. Another way to look at it is that such a journal club, if held
    weekly, would add two hours to the residents weekly time, and a program where two added hours
    result in a problem with compliance with the duty hour standards likely has a duty hour problem.
    Question: Why does the ACGME distinguish between “in-house moonlighting,” which is
    counted under the weekly duty hour limit, and external moonlighting, which is not included?
    The ACGME has two reasons for counting in-house moonlighting toward the weekly duty hours.
    The first is to apply the same standard to all hours residents spend in teaching institutions,
    whether they are part of the required educational program or are spent moonlighting in-house.
    The second reason is to prevent institutions from inappropriately using in-house moonlighting to
    replace clinical service activities residents covered previously as part of the educational program.
    The second reason is that the ACGME's purview extends to teaching programs and sponsoring
    institutions, but not resident activities outside of their educational program. Many perceive the
    ACGME does not have the right to curtail moonlighting or place all moonlighting hours under a
    weekly duty hour limit. In contrast, individual programs and institutions may prohibit or limit
    resident moonlight, and may do so formally via the resident contract.
    Question: What is meant by “sound educational justification” for a request to increase the
    weekly limit on duty hours by up to 10 percent?
    The ACGME’s position is that increase in duty hours above 80 hours per week can be granted
    only when there is a very high likelihood that this will improve the residents’ educational
    experience. This requires that all hours in the extended workweek contribute to resident
    education. An example is that a surgical program needs to demonstrate that residents do attain
    the required case experiences in some categories, unless resident hours are extended beyond the
    80-hour weekly limit, and that all reasonable efforts to limit activities that do not contribute to
    enhancing their surgical skills have already been made.
    Also, programs may ask for an extension that is less than the maximum of 8 additional weekly
    hours, and extension in duty hours may be requested for a given level of the program (the chief
    resident year) or for individual rotations or experiences.
    Question: What is the current ACGME interpretation of the use of the added period of up to six
    hours at the end of a 24-hour duty and on-call shift?
    Answer: The goal of the added hours at the end of the on-call period is to promote didactic
    learning and continuity of care, including ambulatory and surgical continuity. At its June 2003
    meeting, the ACGME approved refined RRC-specific language for appropriate activities for the
    period of up to six hours after the end of the 24-hour period of continuous duty. They include
    RRC specific language detailing acceptable activities, and provide specialty-specific definitions
    of what constitutes a “new patient.” A summary document showing the language for each
    accredited core specialty can be found on the ACGME’s Website under the duty hour pull-down
    menu, under “RRC-specific duty hour language.”
    Questions have arisen on how the “no new patients” requirement applies to ambulatory clinic
    experiences, especially clinics where both new and return patients are seen. The requirement that
    no “new patients” be seen after the 24-hour continuous duty period does not allow post-call
    residents to take part in clinical experiences where all patients presumably are “new patients,”
    such as the Emergency Department (ED) and a new patient clinic. In specialties with longitudinal
    care experiences and those that permit post-call residents to participate in ambulatory clinics,
    programs are encouraged to contact their RRC to learn whether residents may provide care for
    new patients scheduled among the return patients in these clinics.
    Question: How should duty hours be calculated when a resident takes a vacation week?
    Vacation days should always be taken out of the numerator and the denominator for calculating
    averaged duty hours, or on-call frequency. E.g., if a resident is on vacation for one week, the
    hours and the on-call frequency for that rotation should be averaged over the remaining weeks.
    Question: We have heard that the duty hour standards can be “relaxed” over the Christmas
    holidays or other times when the hospital is “short-staffed.”
    The ACGME expects that duty hours in any given four-week period comply with all applicable
    standards. This includes months with holidays, during which institutions may have fewer staff
    members on duty. During the holiday period, residents not on vacation may be scheduled more
    frequently, but the overall scheduling pattern for the month must comply with the common and
    RRC specific duty hour standards, and the schedule during the holidays themselves may not
    violate common duty hour standards, such as the requirement for adequate rest between duty
    periods, or RRC specific standards, such as the Internal Medicine requirement that averaging of
    the frequency of in-house call is not permitted.
    Question: The ACGME has states that it will rigorously monitor duty hours in accredited
    programs, and that the sponsoring institution has the oversight for duty hour. We have that this
    requires the sponsoring institution to do electronic, “real-time” monitoring of duty hours in all
    accredited programs. Is this true?
    The ACGME requires programs and their sponsoring institutions to monitor resident duty hours
    to ensure that they comply with the standards, but it does not specify how monitoring and
    tracking of duty hours should be handled. The only requirement related to ACGME monitoring is
    that all programs complete the six-question duty hour survey on the ACGME’s Web
    Accreditation Database (WebADS) and that this information be reviewed and endorsed by the
    Designated Institutional Official (DIO).
    The ACMGE is aware that a number of approaches exist for monitoring resident hours, from
    resident self-reporting to swipe cards and other electronic measures. All of these have some
    advantages and some drawbacks, with none clearly being superior in every way and in all
    settings. ACGME does not mandate a specific monitoring approach, since the ideal approach
    should be tailored to the program and the sponsoring institution, and the approach best suited for
    neurological surgery will be different from the one most appropriate for preventive medicine,
    dermatology or pediatrics. Programs and institutions may benefit from hearing what has worked
    in settings similar to theirs.
    Question: Now that the common duty hour standards have gone into effect, will the RRCs
    continue to enforce their own more restrictive standards?
    Answer: Yes. The common duty hour standards establish a minimum for all specialties where no
    standards existed prior to July 2003. Specialties with more restrictive standards will continue to
    enforce those. This includes Emergency Medicine, which limits duty hours to 72 per week, and
    Internal Medicine, which does not permit averaging of the requirement that call be scheduled no
    more frequently than every three days.
    Question: Our program only has a few residents and residents prefer to be on call for two days
    during one weekend, so they can have another weekend completely free of duties. Does this
    practice comply with the duty hour standards?
    Answer: It is common in smaller surgical residency programs to have residents on duty one
    weekend (Friday and Sunday for instance), so they can be off the next weekend. As long as the
    call schedule and total duty hours average out within parameters specified by the relevant
    program requirements, this type of every other weekend schedule is acceptable. Note that for inhouse
    call, residents must be accorded adequate rest (generally10 hours) between the two
    weekend duty periods. There are no exceptions to this rule. Thus, in-house call on two
    consecutive nights (e.g., Friday and Saturday) is not permitted, unless the residents are given a
    rest period of about 10 hours between the two duty shifts.

  4. #13
    wolfvgang22 is offline Moderator 514 points
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    moonlighting & nightfloat

    Quote Originally Posted by teratos
    BTW, all residents have to have passed step 2. You can't be a resident without that. G
    Doh! I have no idea what I was thinking!

    Regarding the 80 hour rule, I think it could be a catch-22 to have it or not.
    One hospital might work you 100 hours a week without it, and leave you no time and energy to do any moonlighting. But now that the 80 hour rule is in effect, that same hospital works you 80 hours and you can't moonlight.
    Another hospital may have only ever worked residents a maximum of 80 hours a week, but whereas you could moonlight before, now you can't.

    Thanks so much everyone for clearing up this stuff!

    I'm also planning on doing psych right now, sean. Any programs you recommend?
    Saba University School of Medicine, Class of 2009
    Diplomate, American Board of Psychiatry and Neurology

  5. #14
    sean is offline Member
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    Hi Wolf...,

    I PM'd u.


    Spartan (1999)

  6. #15
    FLK's Avatar
    FLK is offline Temporarily Banned
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    Moonlighting vs. Night Float ?

    Quote Originally Posted by wowmd
    Hey guys, I'm new to this particular forum.
    But what's the difference between moonlighting and night float?
    I think i know what moonlighting is all about, but what is exactly a night float?
    In FREIDA, I noticed that many hospital programs offer moonlighting, but they only offer night float STARTING in their 2nd year....

    Can someone clear this for me?
    well with the new 80 hr garbage, many programs are having residents pull night shifts in order to make up for the lack of on-call doctors doing nights like the old days.

    so if there are 5 residents on the medicine service, for example, one of you might work nights all week, so the daytime people will not exceed their hours. since you are working as a resident, you are not paid extra.

    this could also be done as a moonlighting job, where you come in and do the night, but are paid 50$ an hour ( or more ) to do the same thing, but from my experience , these opportunities are getting smaller since people are under the 80 hr rule and moonlighting might put you over that.

    The good news is that after you become an attending there are no rules as to how many hours you can work.

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